To understand how (we think) EMDR works, I need to explain a bit about trauma. When one experiences a trauma, a disconnect occurs in the brain. Normally, there is a constant flow of information between the area of the brain responsible for our emotions, feelings and sensory inputs and that area responsible for our ability to reason, communicate, understand, and interpret the signals from the emotional/sensory area. But when a significant trauma occurs, these two areas do not communicate in a manner that mediates the situation. Instead, fragmented emotions, feelings and sensory inputs associated with the trauma become frozen in their intensity in the emotional/sensory area, and the distorted cognitions (such as “It was my fault” or “I’m not safe” or “I’m a bad person”) appear similarly frozen in the cognitive areas(s). That’s why later, sometimes years later, an aroma, a sound, a sight or a touch can trigger vivid memories of a trauma – and the deep well of buried emotions associated with it – no matter how innocuous the trigger. (Do you wonder why you cry for no apparent reason in a movie sometimes?) Similarly, unresolved, distorted beliefs linked to a trauma, such as “I’m not loveable” or “I never do anything right,” can amplify disappointments or blows to our self esteem many years later.
Most people recognize that overwhelming life-threatening events – such as war experiences, rape or sexual abuse, muggings or domestic violence – can be traumatic, as do they the effects of natural disasters or random terrorist attacks. But for the second grader, being bullied or peeing his pants when the teacher won’t let him go to the bathroom can be traumatic. For the teenager, being rejected by her boyfriend or her clique, having her parents divorce or one of them die – these can be traumatic as well. For an adult, the loss of her cherished job or the injury that ends his life-long love affair with tennis can sometimes precipitate significant psychological fall-out.
Yet trauma does not affect people equally. Trauma is, in a sense, in the eye of the beholder. Some people who actually witnessed the Twin Towers attacks of 9/11 were not traumatized, while others who watched on television half way around the world were. It appears to have little or nothing to do with the one group being “strong” or the other “weak.” What predisposes one to becoming traumatized appears to be a combination of factors: there’s some evidence of a genetic influence, and there’s a view that what the trauma means to us personally is a significant factor; dysfuctional family environments and a previous history of anxiety or depression can increase one’s risk; but the most compelling evidence for predisposition rests with our previous experience(s) with trauma. In cases where people have had multiple traumatic experiences over the course of their lives, we speak of complex trauma.
EMDR (Eye Movement Desensitization and Reprocessing) was developed and initially researched over 30 years ago, targeting Viet Nam Vets, who, years after the war, still experienced PTSD. Over the years since that study, EMDR has been more widely researched than any other trauma intervention. It has been recognized as an effective, first-line treatment for PTSD by, among others: the American Psychiatric Association (APA), The Department of Veterans Affairs (VA), the Department of Defense (DOD), and numerous other world bodies.
Although the the twenty-four controlled studies done since the initial research validate EMDR as a superior and efficient treatment for PTSD, it has become clear to clinicians who practice EMDR that its effectiveness is impressive in treating numerous other conditions as well: panic attacks, phobias, performance issues and other kinds of anxiety disorders; grief and loss; physical and or sexual abuse; some pain (including phantom pain) disorders; situational depression and low self-esteem related to abuse, abandonment and neglect. There is an increasing amount of research now being done to buttress the evidence that we as clinicians have regularly witnessed.
I was first drawn to EMDR during a seminar in 1999 when watching Bessel van der Kolk, one of the legendary figures in the research and treatment of psychological trauma, present brain images of a man who had experienced a significant trauma: the images showed the man’s hippocampus and amygdala prior to the trauma (baseline), again after the trauma, and yet again following 8 sessions of EMDR. In the post-trauma slides the amygdala was highly activated (lit up, visually), and the hippocampus had lost considerable volume. Following the 8 sessions of EMDR, the man’s hippocampus had regained its volume and the amygdala appeared as it had at baseline as well. These striking images of organic change paralleled the total remission of symptoms which had reportedly occurred. To learn more about EMDR, I took a workshop at the International Trauma Conference a few months later. Immediately thereafter, I decided to become trained in EMDR Therapy – a decision I’ve never regretted..
No one knows precisely how EMDR works – though it was unknown how aspirin worked for years, it was clear that it did. Some of the theories, however, seem increasingly plausible with the evolution of brain imaging techniques, such as SPECT scans – which cannot only show organic changes to the brain when one is traumatized but can also show such changes pre- and post-treatment.
If you recall from the TRAUMA page, when a trauma occurs there appears to be a disconnect between the left hemisphere of the brain (largely, but not exclusively, responsible for our cognitive functions) – and the right hemisphere, more the center of our emotional and sensory experiences.
How does EMDR repair this rupture? What seems to happen is this: while the client focuses on the traumatic memory with its emotions, sensory residue, negative self belief(s), and any current body sensations – all while attending to some form of alternating, bilateral stimulation of the brain (via eye movements, electronic tapping, bilaterally mixed sound or music through ear phones, etc.) – a reconnection of the neural pathways between the two hemispheres of the brain seems to occur. The emotional charge when bringing up the memory starts to decline, and the cognitive distortions begin to resolve. “I’m not safe” or “I must be a bad person” (initially associated with the traumatic memory) becomes (realistically and currently) “I can take care of myself today” or “I like who I am as a person.” When there is no emotional charge or body sensation remaining, and when the negative self-belief has evolved into a positive one to which the client fully subscribes and that can be adaptively used going forward – we speak of the memory being successfully processed. In the language of EMDR, this integration that occurs is called Adaptive Information Processing (AIP).